Mind and Body

Use of Robotic Surgery Increases

People facing surgery may imagine a skillful surgeon using a scalpel with a steady hand, but the real picture is changing.

The skilled surgeon will still be there, but the steady hand might very well not be human. Robotic surgery is becoming a popular alternative to traditional surgical practices.

For example, the number of prostate surgeries performed using robotic instruments increased from 9 percent in 2003 to 43 percent by 2007, according to a 2009 report in the Journal of the American Medical Association (JAMA).

For the surgery, thin tubes containing cameras and robot-controlled surgical instruments are inserted into the body through tiny incisions.

Faster Recovery May Be Possible with Robotics

Experts say that by allowing for less-invasive surgery, a faster recovery is possible.

"You used to have to make a pretty big incision in the pelvis to do prostate surgery," says robotic surgery pioneer Dr. W. Randolph Chitwood, Jr. "With this technology we can now access the internal organs through tiny incisions." Dr. Chitwood is director of the East Carolina Heart Institute and chairman of cardiovascular and thoracic surgery at East Carolina University.

The technology is not flawless. A recent study found that people who underwent minimally invasive robotic prostate surgery had an increased risk of incontinence, erectile dysfunction, and other genitourinary problems.

Surgeons had hoped that the use of robotic tools would protect the nerves around the prostate area by removing some of the movement that exists in even the best-trained hands, says Dr. Otis Brawley, chief medical officer of the American Cancer Society.

Robotics may decrease the shaking, but it does not decrease the amount of trauma to the nerves, he notes.

However, the study found that patients also sustained less blood loss, had fewer complications overall, and were more likely to heal faster and spend less time in the hospital.

Finding the Right Option

Dr. Chitwood says to first research the team that would perform the surgery. He regularly trains surgical teams on the use of robotic instruments.

Successful use of the new technology, he says, depends on whether the surgeons already are skilled at the procedure in question.

"This will not teach you how to repair heart valves," he explains. "But if you take someone who's already performed the operation and already knows what they're doing, this can make the surgery less invasive.

The entire team that will be involved in the surgery should be trained in the use of robotics, says Dr. Chitwood. Surgeons need to know how to use the equipment, and assistants and nurses need to know how to use the technology.

Someone considering robotic surgery also should ask how often a surgeon performs the surgery because repetition builds skill with the equipment, according to Drs. Chitwood and Brawley.

A surgeon who has performed the procedure hundreds of times simply has more experience than someone who's performed it a dozen times.

Also ask about the outcomes of earlier patients, and how those outcomes compare with those of people who had traditional surgery at the medical center in question.

A number of risk factors should be taken into account before choosing robotic surgery over traditional surgical methods, including the prospective patient's age and overall health, says Dr. Chitwood.

And anyone who has a risk factor that increases the chances of complications should seriously consider standard surgery, he advises.

Always consult your physician for more information.

July 2010

Preparing for Your Surgery

Millions of Americans will undergo surgery each year. It is important for you to be informed about the surgery being recommended, particularly if it is elective surgery (an operation you choose to have performed), rather than an emergency surgery (also called urgent surgery).

All surgeries have risks and benefits which you should familiarize yourself with before deciding whether the procedure is appropriate for you.

On the day of surgery, you will meet with the medical team involved in your surgery. This may include your surgeon, the anesthesiologist, and various other healthcare professionals.

Steps before surgery may include changing into a hospital gown, receiving an identification bracelet, an intravenous line inserted in your forearm for anesthetics and other medications, and transportation on a stretcher to the operating room.

The operating room can be an intimidating place, with a lot of unfamiliar technical equipment. The following is a brief list of equipment you may see in the operating room. However, each operating room varies depending on the type of surgery being performed.

The operating table in the center of the room can be raised, lowered, and tilted in any direction. The operating lamp allows for brilliant illumination without shadows during surgery.

You may be connected to various monitors that keep track of your vital signs, such as your heart rate and blood pressure. Sterile instruments to be used during surgery are arranged on a stainless steel table.

A ventilator or breathing machine stands by the head of the operating table. The ventilator will breathe for you during the procedure by moving oxygen and air in and out of your lungs.

If the surgery requires it, a heart-lung machine, or other specialized equipment, may be brought into the room.

Once surgery has been completed, you are brought to the recovery room, which also may be called the post-anesthesia care unit. In the recovery room, clinical staff will closely monitor you as you recover from anesthesia. The length of time spent in recovery depends on the type of surgery performed and the individual patient.

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)